Original article—liver, pancreas, and biliary tract
Changes in the Prevalence of the Most Common Causes of Chronic Liver Diseases in the United States From 1988 to 2008

https://doi.org/10.1016/j.cgh.2011.03.020Get rights and content

Background & Aims

Chronic liver diseases (CLDs) are major causes of morbidity and mortality worldwide. We assessed changes in the prevalence of different types of CLD in the United States.

Methods

National Health and Nutrition Examination Surveys conducted between 1988 and 2008 were used to estimate changes in the prevalence and predictors of CLDs. Serologic and clinical data were used to establish the diagnoses of CLDs in 39,500 adults. Statistical analyses were conducted with SUDAAN 10.0 (SAS Institute, Inc, Cary, NC).

Results

The prevalence rates for CLD were 11.78% (1988–1994), 15.66% (1999–2004), and 14.78% (2005–2008). During the same period, the prevalence of hepatitis B virus infection (0.36%, 0.33%, and 0.34%), hepatitis C virus (1.95%, 1.97%, and 1.68%), and alcoholic liver disease (1.38%, 2.21%, and 2.05%) remained generally stable. In contrast, the prevalence of nonalcoholic fatty liver disease (NAFLD) increased from 5.51% to 9.84% to 11.01%. From 1988 to 1994, NAFLD accounted for 46.8% of CLD cases; from 1994 to 2004 its prevalence increased to 62.84%, and then to 75.1% from 2005 to 2008. During these time periods, steady increases were observed in obesity (21.74%, 30.02%, and 33.22%), visceral obesity (35.18%, 48.16%, and 51.43%), type II diabetes (5.55%, 7.88%, and 9.11%), insulin resistance (23.29%, 32.50%, and 35.00%), and hypertension (22.68%, 33.11%, and 34.08%). A multivariate analysis showed that during all time periods, obesity was an independent predictor of NAFLD.

Conclusions

National Health and Nutrition Examination Surveys data collected from 1988 to 2008 show that the prevalence of major causes of CLD remained stable, except for NAFLD, which increased steadily, along with the prevalence of metabolic conditions. Given the increasing rates of obesity, NAFLD prevalence is expected to contribute substantially to the burden of CLD in the United States.

Section snippets

Study Population

This study was based on data obtained from the National Health and Nutrition Examination Survey (NHANES), a nationwide survey representing the health and nutritional status of the noninstitutionalized civilian US population. The data were collected by the US National Center for Health Statistics of the Centers for Disease Control and Prevention via household interviews, physical examinations, and laboratory data including blood and urine samples collected in designated examination centers. We

Study Population

This study included a cohort of 39,500 adults from 3 NHANES cycles (N = 15,855 from NHANES 1988–1994, 13,970 from NHANES 1999–2004, and 9670 from 2005–2008) with complete clinical, demographic, and laboratory data (Table 1).

Prevalence of Chronic Liver Diseases and Subtypes

Our analyses suggest that prevalence rates for CLDs are steadily increasing: 11.78% ± 0.48% (1988–1994), 15.66% ± 0.41% (1999–2004), and 14.78% ± 0.58% (2005–2008) (P < .0001). The rates for different types of CLDs during the same time period indicate that the prevalence of

Discussion

This is a population-based study assessing changes in the prevalence of common causes of CLD in the United States over the past 2 decades (Figure 1). A major finding of this study is that the prevalence of CLD, in general, is steadily increasing. This increase in the prevalence of CLD suggests that liver disease will remain among one of the major causes of mortality and morbidity in the United States and will be responsible for substantial medical resource use. This issue becomes especially

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    This article has an accompanying continuing medical education activity on page e60. Learning Objectives—At the end of this activity, the learner will recognize the increasing prevalence of nonalcoholic fatty liver disease in the United States, understand the implications of the rising obesity epidemic on the prevalence of nonalcoholic fatty liver disease, and learn that the rates of other important causes of chronic liver disease such as viral hepatitis and alcoholic liver disease have remained stable.

    Conflicts of interest The authors disclose no conflicts.

    Funding This study was supported in part by the Liver Disease Outcomes Fund of the Center for Liver Diseases at Inova Fairfax Hospital, Inova Health System (Falls Church, VA).

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